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. 2020 Jun;37(6):260–267.

TABLE 1.

Studies Reporting Neurocognitive Effects of Steroids in Acute Care/Critical Care Patients

Authors, y Patient Population (No.) Steroid Intervention Study Type (Statistical Analysis) Outcomes
The Boston Collaborative Drug Surveillance Program, 197218 Hospitalized medical (718) Prednisone mean dose 32.2 mg/d Prospective (observational study) Psychiatric reactions reported in relation to dose: ≤ 40 mg (1.3%), 41–80 mg (4.6%), > 80 mg (18.4%)
Rundell and colleagues, 198919 Hospitalized with psychiatric consultation (755) Corticosteroids not otherwise defined Retrospective review (descriptive) Steroids prescribed in 53.8% (7 of 13) of patients with manic syndrome
Gaudreau and colleagues, 200520 Hospitalized cancer (261) Dexamethasone equivalents > 15 mg Prospective cohort (multivariate Cox regression model) Development of delirium was associated with steroid exposure (HR 2.67; 95% CI, 1.18–6.03)
Gaudreau and colleagues, 200721 Hospitalized cancer (114) Dexamethasone equivalents > 15 mg Prospective cohort (χ2 proportions) Odds of probability of delirium were not significant with higher doses of steroids (P = .12)
Schreiber and colleagues, 201422 Medical/surgical ICU (520) Prednisone equivalents median 44 mg (IQR 13–75 mg) Prospective cohort (first-order Markov logistic regression model) Steroids independently associated with the transition to delirium (OR, 1.52; 95% CI, 1.05–2.21)
Wolters and colleagues, 201523 Medical/surgical ICU (1,112) Prednisone equivalents median 50 mg (IQR 25–75 mg) Prospective cohort (first-order Markov logistic regression model) Steroids were not associated with the transition to delirium (OR, 1.08; 95%CI, 0.89–1.32)
Matschke and colleagues, 201624 Hospitalized, immune thrombocytopenia (26) Prednisone 1–2 mg/kg/d vs pulsed dexamethasone 0.6 mg/kg/d Prospective, randomized comparative (Fisher exact test of proportions) Dexamethasone patients reported significantly more insomnia than did prednisone patients (P = .03)
Tilouche and colleagues, 201825 Medical ICU (206) Corticosteroids not otherwise defined Prospective, observational (multivariate regression analysis) Steroid use was independent predictor of developing delirium (OR, 2.8; 95% CI, 1.06–7.28)

Abbreviations: HR, hazard ratio; ICU, intensive care unit; IQR, interquartile range; OR, odds ratio.